Individual
KATELYN MICHELLE FULWIDER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1575 PARKER RD, NIXA, MO 65714-9522
(417) 631-6072
Mailing address
1575 PARKER RD, NIXA, MO 65714-9522
(417) 631-6072
Taxonomy
Speciality
Code
Description
License number
State
224Z00000X
Occupational Therapy Assistant
Primary
2017029562
MO
Other
Enumeration date
08/18/2022
Last updated
08/18/2022
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